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Home My Public Portal About5034 SERENO DR_Building__ APPLICATION FOR BUILDfNG P RMIT 1 COUNTY OF LOS ANGELES BUILDINGt DEPARTM NT OF COUNTY ENGDIEER ADORE88 BUILDING AND SAFETY DrMON LOCALITY / JOHN A LAMBIE. COUNTY ENGINEER NEAREST WILLIAM EN8 Tor Bu CROSS ST DISTRICT NO GROUPE D BY FOR APPLICANT TO FILL IN ='ST BUILDING STATISTICAL CLASSIFICATION 8 ER MAP ADDRESS 6 K CLASS NO HLL UNTTS LOT NO BLOCK MAP ATE �.� NUMBER W.— TRACT fid' _� USEZONE SPECIAL NO OF SLOGS /{ CONDITIONS SIZE OF LOT I NOW ON LOT USE OF EXISTING BLDG BUILDING YARD HWY EET NAME EXIST TEL SETBACK WIDTH OWNER NO rRONT ^ P L ADDRESS SIDE ARCHITECT OR TEL ENGINEER NO INSPECTION RECORD ADDRESS CONTRACTOR Tp ADDRESS r4V DESCRIPTION OF WORK NEW JADD ALTER REPAIR DEMOLISH , SO FT / NO Or NO OF SIZE OR FAMILI USE OF (� STRUCT SIGNATURE ORor APPLICANT VALUATION$ 00 APPR AI DATE INS 1 L PC �d� PKT FOUNDATION LOCATION FEE E FEE O FORMS MATERIALS 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS AP- FRAME FIRE STOPS IG� PLICATION AND STATE THAT THE ABOVE IS CORRECT AND BRACING BOLTS AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND FURNACE LOCATION, b STATE LAWS REGULATING BUILDING CONSTRUCTION GAS VENT DUCTS 1 CERTIFY THAT IN DOING THE WORK AUTHORIZED I LATH INT WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE WORKMEN COMPENSATION LAWS OF CALIFORN uTH EXT SIGNATURE OF USE NUMBER COR- PERMITT ECT AND POSTED ADORES 696V FINA �—� CLYDE N DIRLAM PRINCIPAL ST RAL ENGINEER PLAN CHECK VALIDATION u�r o uex PEBbUT VALIDATION No wx L 6773 SEP ?2230 150CL I m, J� 7t; D SEP ? ? 1 D 3UCJCI JJ WORKER$ COMPENSATION DKLARATION affirm Thor I hove a <errCornpe of ;C..cin l i ro self �, APPLICATION ,FOR BUILDING PERMIT oTb ccopy'te of Workers Com ensahon Insurance copy thereof (Sec 3800 Lab,C ) 1• _ _yam` , 'COUNTY Policy o Company OF_L054ANGELES BUILDING AND SAFETY D Certified copy is hereby furnishedFOR APPLICANT TO FILL IN :. AUDDLRESS n I � Certified copy is filed with the county budding mspec- BUILDING � r _ hon deportment ADDRESS 0 Q �R ✓/v Date z Applicant CITY T ZIP �� LOCALITY CERTIFICATE OF EXEMPTION FROM WORKERS tL++,,0p NO aF BLDG$ NEAREST e COMPENSATION INSURANCE SIZE OF LOT S��.sty tJOW OfJ LOT CROSS ST - (This section need not be completed if the permit is for one ASSESSOR hundred dollars (SIOO)or less ) TRACT BLOCK LOT NO MAP BOOK PAGE PARCEL .-s TEl s USE ZONE I certify that in the performance of the work for which this OWNER 'SGL NO I MAP permit is Issued I shall not employ any person in any manner per. n SPECIAL so m to beco su len to the Works Compen tion Laws ADDRESS L`RL—i �R Zd J —ZT'/ CONDITIONS O �-" cm - Cl zip U Date bcant NOTI TO T If, after rrakmg Cert floor of ARCHITECT OR TEL DISTRICT GGGR�UUUP TYPE FIRE SSED BY O Exemption, you should become subject to the Worker ENGf I I CONST Compensation provisions of the Labor Code you must forth ADDRESS 1u` with comply w,th such provisions or this permit shall be a- deemed revokedCRA STATISTICAL CLASSIFICATION API N LICENSED CONTRACTORS DECLARATION K: CVSS NO DWELL UNITS_ Z I hereby affirm that I am licensed under provisionsof Chopter 9 ADDR p 2.0 .NO (commencing with Section 7000)of Division 3 of the Business and �+ IC SG FT NO OF NO OF C« SEWER MAP Professions Code, and my license is in full force and effect CITY J 6 jW. CLA55 BK pG VALIDATIONIVALIDATION/ Licens r Lir�Gloas SIZE r - STORIES FAMILIES r VALUATION Contractor OF WORT( NEW &_6t♦Contractor Dote - 9 Poo.I am exempt under Sec (F/J ADO ALTER 8 8P C for this reason REPAIR S Date EXISTING BLDG -V r"- DEMOL Signature APPILCANT0 p r o — l FlNAL — # is 3 8 5 9 7 A OWNER BPRINT) UILDER DECLARATION I hereby affirm that I am exempt from the Contractor i License DATEA 111 • 13&25 Law for the following reason (Section 7031 5, Business andADDRESS tO Fl Professions Code) - PRMNT BY • • 1 3 4 2 5 5 ® 1, as owner of theprops fy,r or m employees ywith BUILDING ADDRESS ,1214 -87 ' . '�1 , wages as their sole compensation,will do the work and L y ) \ t the structure n not intended or offered for sale(Section LOCALITY u ` 7041 Business and Professions Code) MOVING TEL �� '') i ❑ 1, as owner of the property, am exclusively contracting CONTRACTOR NO with licensed contractor to construct the project ness (Sec- ADDRESS tion 7044, Busiand Professions Code) REQUIRED T CONSTRUCTION LENDING AGENCY SET BACK YARD ' PROP LIPIE WIDTH I hereby affirm that there is a construction lending agency for FROM the performance of the work for which this permit is issued P L (Sec 3097, Civ C ) SIDE y - - PL Lender's Name g LDMA Ref Y Lender s Address PC Fees P.rmit Fee _ I certify that I have read this application and state that the Inuonce 1.e 10, J LDMA P/C Y above information is correct I agree to comply with all County Invenigohon Fee 8 ordinances and Stare laws relating to buildup construction Ta+ol fee TDMA perm Y R and hereby authorize representatives of this County to enter upon the ave ennon d property for inspec on rposes Z s[E REV9f1111 Y0!UVLANAT01111'LANGUAGE p o phconi o m to